This week, Ontario became the first province to legally ban so-called conversion therapy for LGBT children when it passed the Affirming Sexual Orientation and Gender Identity Act.
Conversion therapy, also known as reparative therapy, is designed to "cure" children and adults from being gay, an effort often associated with religious practices. The same term is used to describe attempts to reverse the gender identity of a child to prevent them from growing up trans.
The Ontario law was introduced as a private member's bill by NDP MPP Cheri DiNovo and was passed unanimously on Thursday by the legislature. It makes conversion therapy illegal for those under 18.
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What is conversion therapy?
Conversion therapy is the widely-discredited practice of attempting to change a patient's sexual orientation or gender identity through counselling, behaviour modification and even medication. It is often linked to religious groups but can also be rooted in psychiatry and psychology.
The best-known group, U.S.-based Exodus International, was affiliated with 260 Christian ministries in North America promoting conversion therapy. The organization shut down and apologized in 2013 for promoting what it admitted was a hurtful and ignorant practice.
In a letter to Ontario's health regulatory bodies this year, Health Minister Eric Hoskins wrote that no credible health organization supports conversion therapy and in fact, most condemn the practice.
"The premise that sexuality or gender identity is a pathology that may be cured through medical or psychological intervention is outdated and potentially damaging to patients," Hoskins wrote, adding this type of therapy is not medically necessary and the province would not pay for the treatment.
Conversion therapy can be as simple as forcing little girls to play with dolls and boys to play with trucks, or more extreme strategies like medication to curb sexual desire, said Helen Kennedy, executive director of Egale Canada Human Rights Trust.
Why is it so controversial?
"There is no evidence that any kind of therapy exists to change a child's gender identity," said psychologist Françoise Susset, who works with the Institute of Sexual Minority Health in Montreal. Susset has treated children after they endured conversion therapy and said they can exhibit depression, self-injurious behaviour and signs of anxiety like hair-pulling at a young age.
Conversion therapy is linked to depression and suicide in a population that is already vulnerable. LGBT youth face 14 times the risk of suicide and substance abuse than their heterosexual peers, according to the Canadian Mental Health Association of Ontario.
For Toronto man Mike Smith, his conversion therapy experience — which included a workbook convincing him his relationship with his family was dysfunctional, group therapy that involved bullying situations, and a prescription for drugs that would make him asexual — nearly drove him to suicide.
Smith, 24, sought reparative therapy through the Mormon church in 2010 to try to reconcile being gay with his religion and later abandoned it after an intervention by friends. He was miserable.
"This program engrained in me that I was indeed broken and had to be fixed somehow," he said. "There was a hopelessness and fear. If I wasn't able to become straight, then there's no reason for living."
The Ontario bill is dedicated to Leelah Alcorn, a transgender teen from Ohio who committed suicide in late 2014. She had blogged about being taken to "Christian therapists" who were "biased" and about her parents wanting her to be a "good little Christian boy."
How had Ontario been paying for it?
Doctors were billing the Ontario Health Insurance Plan for "counselling" hours. While professional or legal consequences must still be sorted out through regulation, the new law sends a "strong message" to doctors in Ontario, DiNovo said.
Where is conversion therapy done?
"It's more or less hidden or covered up," said Susan Gapka, activist and chair of the Trans Lobby Group. "Physicians and psychiatrists don't admit publicly to doing it."
Most often, concerned parents of children who exhibit same-sex attraction or gender non-conforming behaviour, which can cause significant stress in a child, will contact a doctor who may encourage reversion to conventionally heterosexual roles and behaviour.
"In most cases, we find that doesn't work because it's such an innate and internal feeling," said Gapka, a trans woman who links her own attempt to cover up her gender identity with feelings of guilt, shame and eventually, self-destructive behaviour that resulted in being homeless for a decade until she was able to accept herself.
Is it legal elsewhere in Canada?
Manitoba is considering a similar ban and Health Minister Sharon Blady said in May that health professionals should not be billing the Manitoba Health Services Insurance Plan for conversion therapy.
In the United States, the Obama administration has supported a federal ban on conversion therapy for minors. Over 20 states have either introduced or passed legislation making it illegal for licensed professionals to practise conversion therapy for sexual orientation, and have expressed concerns about its potentially tragic outcome.
How prevalent is the practice in Canada?
That's not clear, because practitioners don't advertise themselves as conversion therapists. But at a recent gathering of over 100 LGBT high school students from across the province, DiNovo said at least half raised their hands when she asked who had experienced attempts to change their sexual orientation or gender identity by a doctor.
Some critics of the bill have suggested that gender dysphoria is not linked to sexual orientation and that gender dysphoria can, in some cases, be treated successfully. Others have said the law could make it more difficult for LGBT youth to access care, or that the law was unnecessary and could produce a "chill" among mental health professionals who may be reluctant to discuss gender identity or sexual orientation with their patients.